Make It Last – Ep 71 – Interview with Lisa Kelly & Michelle Gidosh of CareOne Assisted Living

September 8, 2018

This week, starting tomorrow, 9/9 until 9/15, assisted living week will be going on. Assisted living facilities will be hosting events to celebrate those who work and live in the facilities, under the theme of “Capture the Moment.” On Make It Last, this week, Victor interviews Lisa Kelly and Michelle Gidosh of CareOne Assisted Living Facility.  They share what makes CareOne a unique facility as well as what you should look for if you’re shopping for a facility.

Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and Certified Elder Law Attorney (CELA®) and Certified Financial Planner™ professional (CFP). Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.

For more information, visit Medina Law Group or Palante Wealth Advisors.

For more information about what CareOne has to offer visit: www.care-one.com

Click below to read the full transcript

Victor Medina:  Hey everybody, welcome back to Make it Last. I’m your host Victor Medina. I’m so glad you could join us this Saturday morning. I am excited for today’s show, because we have two special guests from CareOne company.

It is Lisa Kelly who is the Regional Director of Business Development and Michelle Gidosh who is the Program Director at the Harmony Lodge at CareOne in Jackson. It is appropriate for me have these two special guests on this week, because coming up starting tomorrow September 9th it’s National Assisted Living Week.

I’m going to talk to you a little bit about different levels of care in this first segment, but then we’re going to spend some time with Lisa and with Michelle talking a little bit about dementia‑centered care generally.

What is it? Why does it differ from traditional assisted living? What people should be looking for in terms of watching out for their elders? What is they should be looking in shopping for an assisted living facility? What is important in that area?

I think this is a good show if you happen to have somebody that is in your life or you know of somebody that is dealing with people who have got cognitive decline. It’s going to be an important set of information that’s going to help you out. I’m excited to have them on here.

It is National Assisted Living Week. That is September 9th through the 15th. Basically, every assisted living facility is going to be hosting different events, essentially, to celebrate that.

There’s a theme for this National Assisted Living Week. It is Capture the Moment. This National Assisted Living Week is, basically, an opportunity for residents, their loved ones, staff, volunteers, local communities, essentially to celebrate the individuals that are served in assisted living and learn more about this sector of long‑term care.

Capture the Moment as a theme hopes to inspire residents to realize their dreams and seize the day. Simultaneously, the theme supports reflection as residents may look back on pivotal moments of their lives.

With the theme wordplay referencing photography, residents may refer to pictures, videos from their past. Those are good ways to trigger memories and get people connected back again to the past.

The theme also aims to remind assisted living staff that often little every day interactions with residents can help deliver super high quality person‑centered or dementia‑centered care.

That’s going to be one of those things that’s really important as you have somebody who is suffering especially from cognitive decline, that they have moments, opportunities, things where they settle back into who they are and who they were before they got crushed with this devastating condition.

What I wanted to do to set the context, because it’s assisted living, many times I think people get confused by the different levels of care that are available as you get older. I want to talk about them. They can be confusing. It is important to understand the different layers that are on there.

Having Lisa and Michelle on later, they’re going to be talking about a specific subset of assisted living that CareOne is focusing on dementia‑related care. Unless you understand where assisted living fits into the spectrum, it’s hard. It’s hard to understand what the specific subset means.

Let’s go through that. I tend to think about assisted living or long‑term care within four different levels that are available. If you’re a notetaker and you just heard me give you the teacher’s prep, bring out the notepad if you’d like to take notes and write stuff down.

We first start at a very low level, which is independent living. Now, independent living is not a form of long‑term care that is absent of anything else. There are some services that service a backstop. For instance, in an independent living center or facility, you have the opportunity to be 100 percent on your own.

You might have a separate apartment. You might have separate town home, with a separate entrance. It might be outside. I remember when my grandmother was getting older she lived in an independent living facility where it was just basically these two homes right next to each other. They were only two rooms in each of them. She had her own kitchen.

What she had the opportunity to do was to avail herself of some additional services that supported her independent living. For instance, she didn’t have to worry anything about the grounds. They were all taken care of.

They had service professionals that were available. If she had a light out or if she had something that needed to be done in the apartment, she could just pick up the phone, and the person in the main lodge would come out to her little hut and help her.

In the form of independent living, you still have a form of long‑term care. It is a backstop or it is a safety net. Just to make sure that if you needed anything to help you continue to live independently, you had that there.

The next layer from that is it can be in either setting. It can be an independent, or it can be back at a home. We’re thinking about aides for home‑based healthcare. You might have somebody that comes into your home to assist you with what we call activities of daily living.

There were six of them. I don’t want to confuse the segment of the show talking about each one of them. If you think about showering and dressing, and getting on with your day, these aides help you with all of those. The next layer above is fully independent living or independent living facility is some form of home‑based care.

You can relayer them so you can have home‑based care in your actual home, or you can have home‑based care in an independent living facility. You can bring somebody in to assist you. The next layer from that is assisted living.

The traditional assisted living gives you additional services, not only it has a backstop for having social workers and nurses available and things like that for medical care. It might have a cafeteria that is preparing all of your meals if you want to take them there.

They’ll have guided activities so that they can help…and those guided activities will be for people with mobility issues, or with cognitive issues, or things like that. It’s a layer above home‑based care and it’s more round‑the‑clock. It’s a facility. You moved in to there and they’re watching over you. The top layer is skilled nursing.

At skilled nursing, it’s basically round‑the‑clock nursing care for you, and for people that are coming off of rehab, for something that they might have in a hospital which somebody, who’s going to be very, very high level of a care, needs. In needs as higher level, we can think about a very extreme levels, somebody is on respirator or something like that. That’s not the highest level.

When Lisa and Michelle come on in the next couple of segments, they’re going to be talking about this dementia‑related part of assisted living. That’s a subset because when somebody has cognitive decline, essentially what’s going on there is that they are being forced to need more and more care, but they don’t need skilled nursing care.

What they need is a form of assisted living that gives them…What I like to call custodio care. Essentially, somebody has custody over them to make sure that they are safe and they are OK. I hope that helps clarify the different levels of care.

When we come back from the break, I’ll have Lisa and Michelle with us. They are going to help talk a little bit more specific about assisted living, what to look for and help guide you in that process. If you need more information at all, you can find stuff is available online. There’s National Center for Assisted Living. You can always email us.

Victor:  We can try to help verify that a little bit more, but you’re really going to be one to get your head around these different levels of care because as you have somebody that you care for, you want to make sure that they are appropriately placed. Stick with us. When we come back on Make It Last, I’ll be joined by two special guests. We’ll be right back, after this break.

Victor:  Welcome back to Make It Last, and joining today with two special guests of CareOne. We got Lisa Kelly who’s the Regional Director of Business Development and Michelle Gidosh who is the Program Director at the Harmony Lodge for CareOne Jackson. Thank you both for joining me today.

Lisa Kelly:  Thank you for having us.

Michelle Gidosh:  Thank you.

Victor:  This is Assisted Living Week, which is exciting because it happens once a year. We are there from September 9 to September 15. Tell me just a little bit about CareOne, because CareOne is really in the assisted living space. That’s been a shift. You used to have skilled nursing and other stuff. Tell me a little bit about where CareOne is as a company now?

Lisa:  We still have the skilled nursing, but we’re branching out into more of the memory care, cognitive impairment, assisted living‑type industry. We just opened in February new one in Paramus. We have our Jackson site which is also about a year old. We’re looking at building a couple more.

We see a definite need for those that have memory impairments that they cannot go to a traditional assisted living. They’re not safe at homes. This is a niche market that were really branching into and growing in the next couple of years.

Victor:  How many facilities overall this CareOne have in New Jersey?

Lisa:  In New Jersey, we’re between 26, 27. It depends on where we are in building. Assisted living‑wise we continue to grow. We have Harmony Lodge communities within some of our traditional assisted livings, which helps those that maybe go into traditional assisted living, and some memory impairment start.

Maybe dementia starts to have them in a neighborhood that’s not safe for them anymore, so they would move into our Harmony Lodge.

Victor:  OK, so they’re those 26 or 27 depending on where there are in building is all over the state, north, south, east, west and every…

Lisa:  Pretty much in every county.

Victor:  OK. Michelle, you’re the Program Director of the Harmony Lodge. Tell me a little bit about what the Harmony Lodge is. What distinguishes the Harmony Lodge as part of CareOne from anything else that’s in CareOne?

Michelle:  Harmony Lodge is a dementia‑specialized assisted living. It’s memory care unit. We specialize in working with dementia residents who may have behaviors that are not thriving in the community, such as at home or in a skilled nursing facility.

We work with them one‑on‑one through many different assessment tools we use to really hone in and determine where they are cognitively. We also look at their physical limitations as well to devise a plan specialized just for their needs.

We look at where they are cognitively and then we set up plan in place in order to devise their care plan. With the care plan, we would implement the activities of daily living, which are their ADLs as far as showering, feeding and those types of activities…

Victor:  What it takes to get through the day.

Michelle:  Exactly.

[crosstalk]

Victor:  They get around to take medication…

Michelle:  Can they walk, can they do that on their own, and then also physical activities as far as social ‑‑ it’s a social model. We do follow a program in dementia‑capable care, which is person‑centered. We look at all of those pieces.

We do an extensive personal interest as far as their preferences, what the routine was daily living at home or into another environment. We really try to accommodate those preferences. Their wake time, let’s say, they’re usually getting up at eight in the morning, that’s when we try to make sure that they’re up and on with their day.

If they prefer to sleep in and they skip breakfast, or they want breakfast later, we’ll make sure they get their breakfast later.

Victor:  I want to pull a couple of threads on that in a second. Lisa help me distinguish between Harmony Lodge and what it’s doing and what a traditional assisted living is, because this seems like it’s a refinement on an earlier model where there was really either assisted living, or they were skilled nursing and old folks home, their nursing homes, something like that.

This seems like it’s something in between. What is that? Is it true that it is a different kind of configuration of it, and what’s the need for creating something like that?

Lisa:  The need we recognize was very high, from people going into rehab or skilled nursing, and then not having a true safe discharge plan.

Victor:  I don’t know how many people I’ve come across, where it’s like, everyone has a story of somebody that they know that is suffering from cognitive decline in some fashion. It seems like it’s so much more prevalent, you can’t run across a dinner party where somebody doesn’t have a connection to somebody that’s suffering for.

I definitely support the idea that it’s been growing. How does this kind of care differ from sort of traditional assisted living?

Lisa:  We take the whole person and maybe it’s a physical along with a cognitive problem that they’re having. We incorporate not only physical, occupational, and speech therapy into their daily routine, but we also train all of the staff members in how to deal with difficult behaviors.

Maybe feeding time someone needs help more with finger sandwiches. It might be a memory problem on how they get their daily routine going. The staff is trained in all areas to deal with them, not only with activities of daily living but at mealtime, are they on a special diet, how are we going to accommodate it.

We really took the nursing aspect and added it to the assisted living aspect, having a nurse around the clock. That’s something a lot of traditional assisted livings don’t have and don’t need to have, they just seem to have someone on call.

Putting the nursing function in with the assisted living and the training for the dementia and Alzheimer’s residents has made this a complete package where you might end up just being in a skilled nursing facility because you have a medical issue. We can actually accommodate that.

Victor:  Without having to elevate the level of care to full time 24/7 skilled nursing. It also sounds to me that the element of social work that you’re bringing to it is sort of on the practical side. Because many times we think about social workers as placement individuals, people that go in. They’re in the hospital.

Their job is to make sure that someone, who’s being discharged, is integrated, but when you’re in a facility like what you guys are creating that social work aspect is really about a practical set of skills to take a resident so that they can thrive and survive in those elements.

Is that what you’re saying Michelle in terms of having to do the assessment and then being able to service the assessment with a way that everybody is trained?

Michelle:  Absolutely. We actually do four separate assessments with the help of therapy as well…

Victor:  Who’s that? That’s all right. You have coming in with the assessments that are coming in, there’s four different ones…

Michelle:  There’s four different assessment tools that we do use.

Victor:  Sure.

Michelle:  We really refine or hone in on exactly where they are and what they’re capable of doing. We really focus on their abilities not their disabilities. We really devise a plan to get them to survive, thrive and to have a better quality of life.

Victor:  Do you find that by focusing on what they’re capable of doing you’re able to maintain a high level for them? In other words, like you stave off the decline by focusing on the stuff they’re good at, rather than servicing the things that they’re deficient at? Is that a good way of saying it?

Lisa:  We call it dementia capable. That’s one of our focus areas, and what we talked to families about. We’re going to focus in on what they are capable of doing to their best ability. It only may be a piece of it, but that actually makes their day go so much better if they’re still able to incorporate it into what they’re doing every day.

Like, “How are they able to brush your teeth? We all don’t do it the same way. Let’s see how they do it. Let’s walk them through it. Let’s make sure that we’re not changing their routine,” because that’s what they’re used to.

We take certain things and that comes from gathering the life story prior to them moving in, and really understanding how their routine was, not changing it. Their interest, how they took care of themselves. Do they take a shower at eight o’clock every night? We don’t want to change that because that’s what they were used to.

Victor:  Probably changing it might cause…in other words, the whole idea that something’s different and strange for somebody it’s already suffering from cognitive decline can add to that the speed of their decline going forward as you’re changing environments you’re changing facility from home or anything like that.

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Victor:  When we come back, I actually want to talk a little bit more about the signals that people should be looking for where they might start to investigate looking at assisted living, because I think that’s one of these barriers people have to overcome in terms of families.

Stick with us, we’ll be right back at Make It Last with Lisa Kelly and Michelle Gidosh from CareOne talking about assisted living in Harmony Lodge, cognitive decline. All is really important stuff in an Assisted Living Week, which is really nice. We’ve seen this out pretty well. Stick with us, we’ll be right back.

Victor:  Welcome back to Make It Last. I’m joined to day from CareOne, CareOne facilities, Care for Homes, CareOne as a company, with Lisa Kelly who’s the Regional Director for Business Development and Michelle Gidosh who’s the Program Director of the Harmony Lodge of CareOne in Jackson, New Jersey.

We left off generally talking about what you’re trying to provide when you are servicing somebody that is dementia capable. What signals should family members be looking for at home? I think that the biggest thing that I see in my legal practice, when people come in, is by the time they’ve called me, hand are up in the air. They’re not ahead of the problem. The wave is crashing over them.

What kind of advice can you start to give both on signals to look for to start the process and then, if you could, talk about why looking at facility‑based care might be an improvement on how they’re managing, how they actually serve the elder in their life.

Let’s first start with the signals. What are people looking for to say, “Look. Maybe this is too much. Let me not be behind the problem but ahead of the problem.”

Lisa:  Well, definitely, when you’re looking in the refrigerator, is the food expired? Are they eating properly? That’s a big sign right there. If they’re calling you multiple times a day asking the same question, definitely. You need to get started looking for somewhere to place somebody.

I think that if they’re confused driving, getting lost a lot, you don’t want the police to start to get involved saying, “We have mom or dad here. They seem lost. They’re driving their car.” I think the simple signs of just having a conversation, asking questions if you think they’re becoming forgetful and, maybe, understanding where they are.

Victor:  True. Is this age‑based at all in a sense? Sometimes, you just get people that are dotty because they are 92. 92 is dotty and not necessarily cognitive decline, the same. Some of them might be younger. You find that the younger they are with these types of issues, the more likely it is that something’s going on.

Lisa:  There’s so many different forms of dementia, cognitive impairments, Alzheimer’s, everything. We are seeing people come in younger, as young as 59.

Victor:  Wow. That’s super young.

Michelle:  That’s really onset.

Lisa:  It’s a form of some type of dementia, whether it’s medical, whether it was medication‑related, or alcohol‑related, anything like that. It just could be a decline going on with your memory to Alzheimer’s amyloid plaque.

Victor:  It seems though that there’s no “too young” age to have suspicions about what’s going on. You can’t walk around saying, “Well, because they’re only early 60s, it can’t really be happening.” No. You should probably be keeping your eyes out to see if it is happening.

Now, you’ve identified a reason to be investigating that, what’s the next step? Is there a matter of an assessment? Do assisted living facilities assist with even figuring out if it’s appropriate for that?

You guys aren’t looking for somebody to put into a facility that wouldn’t thrive. They would be better if they were moved from the home. What are you looking for to make that kind of determination to talk to the families about that?

Lisa:  Families need to focus on a couple of different things. Do your research. There’s plenty of online sites that can give you good information, star ratings, customer reviews, things like that. When you’re looking for an assisted living, you need to make sure that your staff ratios are pretty good.

Victor:  What’s a good number to look for that? What do you think is a good barometer? Say we’re past this, if it’s…

Lisa:  If it’s memory care, you’re probably in the 1:6, 1:8 range. Is there a nurse?

Victor:  Are you saying that there are some…?

Lisa:  Some have a nurse around the clock like we do, very few actually. Others have a nurse that’s on‑call.

Victor:  I see. It’s not just the one that’s available but one that’s on site so that they can respond in a crisis to whatever is going on because they’ve got additional medical training than just ‑‑ I don’t call them aides ‑‑ but the people that don’t have a nursing degrees, care partners. That’s fine. We’re looking for that stuff to try to figure out if that’s…

Lisa:  Yes. You also want to make sure that physicians come in if there’s some behaviors going on. Do you have psychiatry that also comes in? We have a psychiatry team that comes in twice a week because we’re dealing with individuals that have some behaviors. They do have a memory impairment that will cause sundowning, maybe some agitation. You need to find the best fit for you.

Victor:  Just for everybody else, before we leave that, just for people that are unaware, what is sundown. What is that?

Lisa:  Sundowning is used to start at sundown. It would be some type of behavior going on, whether it’s angry, sad. Just some kind of emotion is going on because they’re confused at the sun going down and it’s getting darker out. They may get scared. We’re actually seeing it a little bit earlier now other than sundowning.

Michelle:  Usually one, two o’clock in the afternoon. Basically, what it is, it stems from overstimulation from all day doing different activities, being up, being around people, the external or environmental stressors. They’re done by then. We wake up at our best every morning. By the end of the day, we’re pretty much done.

Victor:  I’ve seen a lot of research that suggest, if you want to start making this, that your capability to make decisions goes down over time. If you take somebody who’s got impairment in that area and then you ask them to survive all day, the gas tank will, kind of, an E at the beginning. By the time they get to one or two o’clock, it’s likely that they’re done with that.

What Harmony Lodge is creating with the Harmony umbrella, Michelle, from the Program Director stand point, what do they do to help somebody in that situation make it through? They’re not going to go to bed at one or two o’clock. You’re not going to put them in stasis over in a room. What is programing help for that?

Michelle:  I’m glad you asked. Our programing is really set up to maximize, again, their abilities opposed to other disabilities. We do find with some of our residents that they crash towards the end of the day.

The programing is set up. In the morning we start up with physical activity, then cognitive activity and/or music. We have a lot of live entertainment that does come in. We have arts and crafts.

We have a painting company that does come in and does art class. Throughout the day, there are a lot of activities or programs that specialize or adapt into specific levels of cognitive abilities. We’ll split off. We’ll do dual programing. The lower levels will do one program. The higher levels will do another program so that they can function or thrive to their best of what they can do.

Victor:  I’m a simple guy. I just want to understand. Does that mean that by keeping them occupied at the level that is appropriate for them, we stave off the stuff that makes them scared, that might otherwise get them possibly in danger? Is that the idea behind it?

Michelle:  That is, actually. If we don’t overchallenge them and they can do the activity, that’s not going to stimulate or cause agitation.

Victor:  I see.

Michelle:  Towards the end of the day, we will do more relaxed activities. We will do spa day. We will do music, relaxation music. We’ll have lower functioning activities for all of the residents so that we can bring them down towards the end of the day. They would go into dinner and then by then, we would do, in the evening, normalizing activities.

If it’s watching a movie or doing puzzles or getting their nails done. Something to really bring them in, close the day off and let them be able to relax and rest at night.

Victor:  That’s perfect. I want to thank you both for joining us here today. Tell us a little bit of what’s going on. I know that care is so big in a community. Do you guys have stuff that’s going on for Assisted Living Week or anything that’s coming up in the future that you’d like to talk about?

Lisa:  Yes. We’re actually kicking off Assisted Living Week. It’s actually Grandparents Day as well. We’re having some entertainment. It’s a tribute to Frank Sinatra. That should be fun. We have activities all week long from other musical guests. We’re doing a luau. We’re doing a drive‑in movie theater. Just a lot of good activities.

Victor:  Where can people find out more about that? Because you guys have stuff in all kinds of facilities across the state. Where can they find out more information?

Lisa:  You can call 87799‑CARE‑1 or go to our website, www.care‑one.com. All of our events are posted there. You can look at anything going on for the next couple of months if you’re interested in attending.

Victor:  Great. So that’s www.care‑one.com, just in case you guys just want to check that out a little bit more. First, thanks so much for both of you coming in and sharing that great information.

If you guys have more questions, you can certainly continue the conversation online. Send us an email. Send additional questions. We will forward them on to our guests and make sure that they know more about them and respond to you.

Otherwise, if you like this episode and you know of somebody that is suffering with somebody in their family that has cognitive decline or in the beginning of, the best thing you can do is to share this information with them. If you’re listening live, you can go onto our podcast site. It’s on Apple iTunes. You can go to Spotify and essentially share this episode with them.

The best way to do that, Spotify is free. Apple iTunes is free. They can go back episode 70, listen to this, and be able to get the benefit of all this information. This has been Make It Last, where we keep your legal ducks in a row and your financial nest egg secure. We’ll catch you next Saturday. Bye.

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